Transgender social contagion and ROGD

“Young people become trans because they see it on social media.” “It’s a trend spread among friends.” “There weren’t all these transgender people before.” These claims circulate regularly in public debates, in the media, and even in some legislative proposals. At their core is a seemingly intuitive idea: that gender identity can be “contagious,” like a virus, through exposure to online content or contact with transgender peers.

This idea has a scientific name: the theory of transgender social contagion. It also has a clinical abbreviation — ROGD, Rapid Onset Gender Dysphoria — coined in a 2018 study that generated enormous controversy. But what does the research actually say? Has this hypothesis withstood scientific scrutiny? And why do the world’s major medical organizations reject it?

What is ROGD: the hypothesis and Littman’s study

The term “Rapid Onset Gender Dysphoria” was introduced by Lisa Littman in a study published in PLOS ONE in 2018 [1]. The hypothesis held that some adolescents — particularly those assigned female at birth — developed gender dysphoria suddenly during or after puberty, influenced by transgender peers and exposure to content on social media.

The study was based on an online survey of 256 parents [1]. Littman asked parents to describe the moment when their children had shown signs of gender dysphoria, their friendships, and their social media use. Parents reported that the dysphoria seemed to appear “suddenly,” often coinciding with greater exposure to trans content online and in friend groups where other young people also identified as transgender.

Based on these responses, Littman formulated the hypothesis that transgender identity could, in some cases, spread through “social contagion” among peer groups [1].

The methodological problems of the study

Littman’s study received deep and systematic criticism from the scientific community. The problems are multiple and concern every aspect of the research: from the sample to the methodology, from the conclusions to the language used.

The sample: parents recruited from anti-trans websites

The most serious problem concerns recruitment. Parents were not selected randomly or representatively. The survey was posted on three websites — 4thwavenow, transgendertrend, and youthtranscriticalprofessionals — known for their critical positions toward transgender identity in young people [3]. As highlighted in the methodological critique by Restar (2020) published in Archives of Sexual Behavior, this approach creates a systematically biased sample: parents who frequent anti-trans websites are more likely to interpret their children’s identity as externally influenced [3].

Informed consent as a source of bias

Restar also highlights another significant problem: the informed consent form presented parents with the premise of “social contagion” before they completed the survey [3]. This priming approach — presenting a hypothesis to participants before collecting data — is a known source of bias in social sciences. Parents predisposed to agree with the premise were more motivated to participate, and their responses were influenced by the expectations created by the consent form itself.

No data from the people themselves

The study included no data from the adolescents themselves, nor from the clinicians treating them [3]. The conclusions about the gender dysphoria of young people were based entirely on parents’ perceptions — parents who, in the majority of cases, did not accept their children’s gender identity. As Restar observes, parents are not qualified to make clinical diagnoses, and the perception of a “rapid” onset from a parental perspective does not necessarily correspond to the reality of the young person’s experience [3].

Many transgender people report having experienced gender incongruence for years before communicating it to their parents. What appears “rapid” from the outside may be the result of a long internal process of working through things and, finally, disclosure.

The PLOS ONE correction

The criticisms were so significant that PLOS ONE initiated a post-publication review. In March 2019, the journal published a formal correction of the study, with editor Joerg Heber apologizing “to the trans and gender variant community” for the prior review and publication [2]. The editorial note clarified that “the study, including its goals, methodology, and conclusions, were not adequately framed in the published version.” The same correction reiterated that ROGD “is not a formal mental health diagnosis” and that the study “does not validate the phenomenon” [2].

The evidence against social contagion

If the social contagion hypothesis were correct, we should observe some specific patterns in the data. The studies that looked for them did not find them.

The Turban et al. study (2022)

The largest and most rigorous study on the social contagion hypothesis was published in Pediatrics by Turban, Dolotina, King, and Keuroghlian in 2022 [5]. The researchers analyzed data from the Youth Risk Behavior Survey of the Centers for Disease Control and Prevention (CDC) — a sample of approximately 100,000 high school students per year, collected in 16 American states in 2017 and 2019.

The results directly contradict the predictions of the social contagion theory [5]:

• The percentage of adolescents identifying as transgender did not increase between 2017 and 2019.
• Adolescents assigned female at birth were not overrepresented among transgender youth, contradicting a key prediction of the ROGD hypothesis.
• Trans youth assigned male at birth outnumbered those assigned female in both years.

If social contagion were real and particularly affected girls (as Littman claimed), we would expect the opposite.

Additionally, the study found that approximately 39% of transgender youth reported episodes of school bullying in 2017, compared to 17% of cisgender heterosexual peers. In 2019, the numbers rose to 45% and 17%, respectively [5]. These extremely high rates of discrimination are inconsistent with the idea that young people identify as trans for “popularity” or “trendiness.”

The Bauer et al. study (2022)

Another foundational study was published in The Journal of Pediatrics by Bauer, Lawson, Metzger, and the Trans Youth CAN! team [6]. The researchers analyzed clinical data from transgender adolescents across 10 Canadian medical centers.

The study tested a series of associations that would be consistent with the ROGD hypothesis: if this were a real and distinct phenomenon, one would expect to find two recognizable groups of patients with different timelines for the development of their gender identity. The results: none of the associations predicted by the ROGD hypothesis were confirmed by clinical data [6]. As Bauer observed, “if ROGD were real, we would expect to see two distinguishable streams of patients with different gender identity timelines — but we did not find them.”

Furthermore, 98.3% of the young people seeking gender-affirming care had realized they might be transgender more than a year earlier [6]. This finding is incompatible with a “rapid” onset caused by recent external influences.

Why there are “more transgender people” today

The increase in the visibility of transgender people is real. But the interpretation — that this increase is caused by social contagion — is not the only possible one, and it is not the one supported by the evidence. The scientifically more robust explanation is another: the increase is linked to the reduction of stigma and the improvement of access to services.

The historical precedent: left-handed people

The most illuminating parallel comes from the history of left-handedness. At the beginning of the twentieth century, the percentage of left-handed people in the population was around 3-4%. Over the course of the century, this percentage rose to stabilize around 12%.

What had happened? Had people suddenly “become” left-handed? No. For centuries, left-handed people had been forced to use their right hand — with punishments, social stigma, and even “corrective” interventions. When these pressures ceased, people simply were able to express a characteristic they had always had. The real number of left-handed people had not changed: what changed was the number of left-handed people who were visible.

The same pattern applies to transgender people. Historian Jules Gill-Peterson, in her work “Histories of the Transgender Child” (2018), demonstrates through extensive archival research that transgender children are not a new phenomenon: they existed — and sought medical help — as early as the first decades of the twentieth century, long before social media, the internet, or contemporary pop culture [10]. What has changed is not the number of trans people, but society’s ability to see them and allow them to exist openly.

The factors behind increased visibility

The Endocrine Society, in its 2020 position statement on transgender health, recognizes that “there is a durable biological element underlying gender identity” and that “there do not appear to be external forces that genuinely cause gender identity change in individuals” [8]. The increase in visibility is attributable to well-documented factors:

• Greater awareness: people have access to information and language to describe experiences that previously had no name.
• Reduced stigma: in many contexts, identifying as transgender carries fewer risks than in the past, although risks remain significant.
• Improved access to care: more healthcare professionals are trained on gender identity, making it easier to seek support.
• Changed diagnostic criteria: revisions of the DSM and ICD have expanded and updated definitions, reflecting a more accurate understanding of gender diversity.

What major medical organizations say

The scientific consensus on ROGD is clear: it is not a recognized diagnosis, and the social contagion hypothesis is not supported by evidence.

The CAAPS and the 60 signatory organizations

In 2021, the Coalition for the Advancement and Application of Psychological Science (CAAPS) released a formal statement calling for the elimination of the concept of ROGD from clinical and diagnostic use [7]. The statement affirms that “there are no robust empirical studies on ROGD” and that the concept “has not been subjected to the rigorous peer review processes that are standard for clinical science” [7]. The statement was signed by over 60 organizations, including the American Psychological Association and the American Psychiatric Association.

The Journal of Adolescent Health (2023)

In 2023, an editorial published in the Journal of Adolescent Health explicitly stated that “Rapid-Onset Gender Dysphoria is not a recognized mental health diagnosis” [11]. The editorial emphasized that the use of the term in clinical contexts risks stigmatizing transgender youth and compromising their access to care.

WPATH

The Standards of Care Version 8 of the World Professional Association for Transgender Health (WPATH, 2022) do not recognize ROGD as a distinct clinical entity [9]. The guidelines reiterate that gender diversity is a normal aspect of human diversity and that many transgender people experience gender incongruence from childhood or adolescence.

The Endocrine Society

The Endocrine Society states in its 2020 position statement that “there is a durable biological element underlying gender identity” and that the current medical consensus no longer considers transgender identity as a mental disorder influenceable by external factors [8]. The society reaffirms that gender-affirming care is evidence-based and necessary for the well-being of transgender people.

Social media: cause or mirror?

The idea that social media “make” young people trans deserves specific analysis, because it is at the center of the social contagion narrative.

Social media can indeed play a role in the experience of transgender people, but not in the way suggested by the contagion theory. They can help young people find language to describe experiences they are already living, discover that other people share those experiences, and access information about available care pathways.

This is a process of discovery, not creation. The difference is fundamental. A left-handed person who discovers online the existence of left-handed scissors has not “become” left-handed through internet influence. They simply found a tool that corresponds to a characteristic they already had.

The Turban et al. study (2022) offers a particularly relevant finding on this point: if social media caused transgender identity, we would expect an increase over time in the percentage of young people identifying as trans (given the continuous increase in social media use). This increase did not occur between 2017 and 2019 [5].

Zucker (2019), in a reflection on contemporary clinical issues related to adolescents with gender dysphoria published in Archives of Sexual Behavior, acknowledges that media and the internet may facilitate awareness, but draws a clear distinction between facilitation of awareness and causation of identity [12].

ROGD as a moral panic

Florence Ashley (2020), in a critical commentary published in The Sociological Review, places ROGD within a broader framework: not as a failed scientific hypothesis, but as an expression of a moral panic [4]. Ashley argues that the concept was constructed to circumvent the growing body of research supporting gender-affirming care, offering a seemingly scientific justification for concerns that are actually cultural and political.

This analysis finds support in several elements:

• The origin of the term: ROGD did not emerge from clinical practice or epidemiological research, but from parent forums that already rejected their children’s identity [4].
• Political use: the concept was quickly adopted in legislative debates to justify restrictions on access to care for trans youth, often without any reference to the scientific literature that refuted it.
• Historical pattern: every wave of greater visibility of LGBT+ people has been accompanied by theories of “recruitment” or “contagion” — from homosexuality in the 1970s and 1980s to bisexuality, to transgender identity today.

The limits of the debate

This does not mean that there are no legitimate questions about the increase in referrals to gender clinics, about best clinical practice for adolescents, or about the experience of young people exploring their gender identity. These questions deserve answers based on rigorous research and clinical data, not on surveys conducted among parents recruited from websites that had already concluded their children had been “contagious” [3].

As Zucker (2019) observes, research on gender dysphoria in adolescents faces real challenges: the increase in clinical referrals, the change in sex ratio, questions about persistence and desistance [12]. These challenges require large-scale prospective studies with direct clinical data, not hypotheses built on unverified parental perceptions.

What we know and what we don’t know

We know that:

• The social contagion hypothesis is not supported by peer-reviewed studies based on clinical data or representative samples [5][6].
• ROGD is not a diagnosis recognized by any major medical or psychological organization [7][11].
• Littman’s study (2018) had serious methodological problems acknowledged by the very journal that published it [2][3].
• CDC data on over 100,000 adolescents do not show the patterns predicted by the social contagion theory [5].
• Canadian clinical data on transgender adolescents do not support the existence of a distinct “rapid-onset” pathway [6].
• The increase in trans visibility is consistent with the reduction of stigma, as demonstrated by the historical precedent of left-handedness and other minority characteristics [10].
• Over 60 scientific and medical organizations have called for the elimination of ROGD from clinical use [7].

We do not yet fully know:

• The specific biological mechanisms underlying gender identity, although the evidence for a biological component is strong [8].
• How to optimize clinical pathways for adolescents with gender dysphoria [12].
• The exact rate of persistence and desistance in large, diverse samples.

The existence of open questions does not justify the adoption of unsupported hypotheses. In medicine and science, “we don’t know everything yet” is not equivalent to “any hypothesis is equally valid.”

The real impact of the contagion narrative

The theory of social contagion is not just a wrong scientific hypothesis. It has real consequences on the lives of transgender people, particularly young people.

When parents, teachers, or legislators believe that a young person’s gender identity is the result of a “trend” or “contagion,” the responses are predictable: denial of identity, delayed access to care, attempts at “correction,” forced social isolation. These responses, well documented in the literature on the mental health of trans people, are associated with significant negative outcomes — including depression, anxiety, and suicidal ideation.

The stakes are not academic. Behind the statistics are real people — adolescents trying to understand who they are, in a world that too often prefers to explain their existence as a mistake, a trend, or a contagion, rather than listening to them.

A summary of the evidence

The theory of transgender social contagion and ROGD have not withstood scientific scrutiny. The original study was based on a biased sample [3], did not include data from the people themselves [3], and its conclusions were corrected by the very journal that published them [2]. Subsequent studies, conducted on large samples with direct clinical data, found no evidence of social contagion [5][6]. The world’s major medical and psychological organizations reject the concept [7][8][9][11].

The increase in the visibility of trans people is not a sign of an epidemic. It is a sign of a society that, slowly and unevenly, is learning to recognize the diversity that has always existed [10]. As with left-handed people, as with gay and lesbian people, the question is not “why are there more of them?” but “why couldn’t they be visible before?”

Science does not have all the answers. But on the fundamental questions — can gender identity be contagious? is ROGD a real clinical phenomenon? — the answer from the evidence is clear. No.